Percutaneous Endoscopic Gastrostomy Placement under NIV in Amyotrophic Lateral Sclerosis with Severe Ventilatory Dysfunction: A Safe and Effective Procedure

Introduction: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder with an inexorably progressive course which leads to a progressive neuromuscular weakness. Weight loss is one of the major bad prognostic factors in ALS. The placement of percutaneous endoscopic gastrostomy (PEG) is of...

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Autores principales:	Rui Gaspar, Rosa Ramalho, Rosa Coelho, Patrícia Andrade, Miguel R. Goncalves, Guilherme Macedo
Formato:	article
Lenguaje:	EN
Publicado:	Karger Publishers 2021
Materias:	percutaneous endoscopic gastrostomy amyotrophic lateral sclerosis severe ventilatory impairment Diseases of the digestive system. Gastroenterology RC799-869
Acceso en línea:	https://doaj.org/article/968e9e3d79e04945922bf24520fc0ee4
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spelling	oai:doaj.org-article:968e9e3d79e04945922bf24520fc0ee42021-12-02T12:40:23ZPercutaneous Endoscopic Gastrostomy Placement under NIV in Amyotrophic Lateral Sclerosis with Severe Ventilatory Dysfunction: A Safe and Effective Procedure2341-45452387-195410.1159/000519926https://doaj.org/article/968e9e3d79e04945922bf24520fc0ee42021-11-01T00:00:00Zhttps://www.karger.com/Article/FullText/519926https://doaj.org/toc/2341-4545https://doaj.org/toc/2387-1954Introduction: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder with an inexorably progressive course which leads to a progressive neuromuscular weakness. Weight loss is one of the major bad prognostic factors in ALS. The placement of percutaneous endoscopic gastrostomy (PEG) is of paramount importance in patients with dysphagia to improve the disease outcomes, although some fear exists regarding the possible ventilatory complications during the procedure. The aim of this study was to evaluate the safety and effectiveness of PEG tube insertion under non-invasive ventilation (NIV) in patients with ALS and severe ventilatory impairment. Methods: A retrospective study of all consecutive PEGs placed in our department from May 2011 to January 2018 in patients with ALS was performed. The procedure was performed under non-invasive positive-pressure ventilation for ventilatory support. Results: We included 59 patients with ALS with severe ventilatory impairment, 58% were female, with a mean age of 67.2 ± 10.1 years and a median follow-up of 6 [2–15] months. The main indication for PEG placement was dysphagia (98%). The median time for PEG tube insertion since the established diagnosis of ALS was 12 [6–25] months and 4 [2–18] months since the beginning of bulbar symptoms. The majority of the patients had placed a 20-Fr PEG (63%) and under mild sedation with midazolam (80%), all under NIV. There were no immediate complications during and after the procedure (no episodes of aspiration or orotracheal intubation) and mortality. Conclusion: The placement of PEG is a very important procedure in patients with ALS and severe ventilatory impairment. The interdisciplinary department collaboration permitted the placement of PEG under NIV, in a safe and effective procedure in this special population.Rui GasparRosa RamalhoRosa CoelhoPatrícia AndradeMiguel R. GoncalvesGuilherme MacedoKarger Publishersarticlepercutaneous endoscopic gastrostomyamyotrophic lateral sclerosissevere ventilatory impairmentDiseases of the digestive system. GastroenterologyRC799-869ENGE: Portuguese Journal of Gastroenterology, Pp 1-7 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	percutaneous endoscopic gastrostomy amyotrophic lateral sclerosis severe ventilatory impairment Diseases of the digestive system. Gastroenterology RC799-869
spellingShingle	percutaneous endoscopic gastrostomy amyotrophic lateral sclerosis severe ventilatory impairment Diseases of the digestive system. Gastroenterology RC799-869 Rui Gaspar Rosa Ramalho Rosa Coelho Patrícia Andrade Miguel R. Goncalves Guilherme Macedo Percutaneous Endoscopic Gastrostomy Placement under NIV in Amyotrophic Lateral Sclerosis with Severe Ventilatory Dysfunction: A Safe and Effective Procedure
description	Introduction: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder with an inexorably progressive course which leads to a progressive neuromuscular weakness. Weight loss is one of the major bad prognostic factors in ALS. The placement of percutaneous endoscopic gastrostomy (PEG) is of paramount importance in patients with dysphagia to improve the disease outcomes, although some fear exists regarding the possible ventilatory complications during the procedure. The aim of this study was to evaluate the safety and effectiveness of PEG tube insertion under non-invasive ventilation (NIV) in patients with ALS and severe ventilatory impairment. Methods: A retrospective study of all consecutive PEGs placed in our department from May 2011 to January 2018 in patients with ALS was performed. The procedure was performed under non-invasive positive-pressure ventilation for ventilatory support. Results: We included 59 patients with ALS with severe ventilatory impairment, 58% were female, with a mean age of 67.2 ± 10.1 years and a median follow-up of 6 [2–15] months. The main indication for PEG placement was dysphagia (98%). The median time for PEG tube insertion since the established diagnosis of ALS was 12 [6–25] months and 4 [2–18] months since the beginning of bulbar symptoms. The majority of the patients had placed a 20-Fr PEG (63%) and under mild sedation with midazolam (80%), all under NIV. There were no immediate complications during and after the procedure (no episodes of aspiration or orotracheal intubation) and mortality. Conclusion: The placement of PEG is a very important procedure in patients with ALS and severe ventilatory impairment. The interdisciplinary department collaboration permitted the placement of PEG under NIV, in a safe and effective procedure in this special population.
format	article
author	Rui Gaspar Rosa Ramalho Rosa Coelho Patrícia Andrade Miguel R. Goncalves Guilherme Macedo
author_facet	Rui Gaspar Rosa Ramalho Rosa Coelho Patrícia Andrade Miguel R. Goncalves Guilherme Macedo
author_sort	Rui Gaspar
title	Percutaneous Endoscopic Gastrostomy Placement under NIV in Amyotrophic Lateral Sclerosis with Severe Ventilatory Dysfunction: A Safe and Effective Procedure
title_short	Percutaneous Endoscopic Gastrostomy Placement under NIV in Amyotrophic Lateral Sclerosis with Severe Ventilatory Dysfunction: A Safe and Effective Procedure
title_full	Percutaneous Endoscopic Gastrostomy Placement under NIV in Amyotrophic Lateral Sclerosis with Severe Ventilatory Dysfunction: A Safe and Effective Procedure
title_fullStr	Percutaneous Endoscopic Gastrostomy Placement under NIV in Amyotrophic Lateral Sclerosis with Severe Ventilatory Dysfunction: A Safe and Effective Procedure
title_full_unstemmed	Percutaneous Endoscopic Gastrostomy Placement under NIV in Amyotrophic Lateral Sclerosis with Severe Ventilatory Dysfunction: A Safe and Effective Procedure
title_sort	percutaneous endoscopic gastrostomy placement under niv in amyotrophic lateral sclerosis with severe ventilatory dysfunction: a safe and effective procedure
publisher	Karger Publishers
publishDate	2021
url	https://doaj.org/article/968e9e3d79e04945922bf24520fc0ee4
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Percutaneous Endoscopic Gastrostomy Placement under NIV in Amyotrophic Lateral Sclerosis with Severe Ventilatory Dysfunction: A Safe and Effective Procedure

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